More about Impotence (Erectile Dysfunction)

Impotence is the inability to have and maintain an erection sufficient for sexual intercourse. Owing to the negative connotations and misconceptions surrounding the word impotence, the problem is more commonly called erectile dysfunction, or simply, ED.

According to some experts, erectile dysfunction is the most widespread sexual problem among American men. Nearly all men experience occasional brief episodes of ED because of routine or temporary causes such as fatigue, emotional stress, or illness. For some people erectile problems become chronic. While ED may be connected to diminished sexual desire, in most cases it is not linked to libido (the emotional or psychic component of sexual desire), nor does it affect the ability to have an orgasm.

Erectile dysfunction can occur at any age, but it’s more common as men grow older. An estimated 5 percent of American men are impotent at age 40; among those over age 65, the proportion increases to 15 to 25 percent. However, the problem is not an inevitable consequence of aging. The causes are complex, combining physical and psychological factors. While the vast majority of men with ED can be helped, many experts believe that as many as 90 percent do not seek medical assistance because of fear of embarrassment and a belief that nothing can be done medically. This is unfortunate, because once underlying medical conditions and psychological factors are addressed, the frequency and duration of erections nearly always improves. Most men with erection problems don’t have to live with them.

Symptoms of Erectile Dysfunction

Persistent difficulty achieving and maintaining an erection for a period long enough to engage in sexual intercourse

Fewer nighttime erections

What Causes Erectile Dysfunction?

In the past, more than 90 percent of all cases of ED were attributed to emotional causes. However, experts currently estimate that only about 10 percent of cases are purely psychological in origin.

An erection depends upon many physical factors, including the blood supply and nerve tissue in the penis, as well as hormones. Circulatory problems, nerve disorders, heart disease, diabetes, and the side effects of certain medications (tranquilizers, blood pressure medications, antidepressants, and anti-inflammatory drugs) can contribute to impotence. Smoking, excessive use of alcohol, and low levels of the hormone testosterone may also come into play. Impotence can also result from prostate surgery or radiation treatment for cancer.

Psychological factors, including stress, depression, and performance anxiety, believed to play a limited role in cases of ED. When such factors are involved, it is mostly in men under age 40. But even in older men, emotions and sexual history may complicate physical factors.

What If You Do Nothing?

Frequent or chronic erectile problems are unlikely to improve without some form of intervention, particularly among men over the age of 50. There are proven treatments for ED, but out of embarrassment and/or a lack of knowledge about medical solutions, many men choose to do nothing about their ED, which often leads to emotional distress.

Home Remedies for Impotence

If you are having erectile problems, it’s a good idea to seek a medical evaluation. If you have an underlying illness, early treatment may restore sexual potency.

Becoming more informed about sexual matters, undergoing treatment for physical problems, giving up smoking, and reducing excessive alcohol consumption can all contribute to restoring potency. If ED occurs only occasionally, some of the following measures may help addressand solvethe problem.

Exercise regularly. In addition to improving blood flow, regular moderate exercise—for example, walking, swimming, jogging, bicycling, or resistance traininghelps raise energy levels, boosts physical awareness, and stimulates sexuality. Be aware that bicycle riding carries with it a risk of seat or crossbar injuries to the perineal nerves (located just behind the scrotum) that can lead to ED.

Eat a healthy well-balanced diet.

Limit alcohol intake. ED among men in their late 40s and 50s is associated more often with excessive alcohol consumption than with any other single factor. There are plenty of other health-related reasons to avoid excessive drinking, so if it appears to be dampening your sex life, cut back or avoid alcohol altogether.

Reduce stress in your life. Stress and other emotional difficulties can affect the brain and thereby decrease libido and the ability to achieve or maintain a suitable erection.

Stop smoking. Smoking has not been found to be a direct cause of ED. However, research has found that when smoking is combined with other risk factors, such as heart disease, high blood pressure, and untreated arthritis, ED levels are consistent and extremely high.

Lose weight. Obesity is not a direct cause of ED, but researchers know that being overweight is associated with the onset of diabetes and the buildup of fatty deposits on the interior walls of arteries, and both of these problems are certainly linked with ED.

Relieve your anxieties. Not every sexual experience has to end with orgasm. Thinking that you must achieve a climax can make you anxious, which can result in ED. Instead, you and your partner can agree to focus on caressing and kissing rather than having an orgasm. This may relieve performance anxiety.

Medical Treatments for ED

Several methods have been developed to treat impotence that is caused primarily by physical factors. If you decide to try any, talk to your doctor about starting with the least invasivethe oral prescription drug Viagra (sildenafil citrate). Viagra improves blood flow to the penis to allow an erection, and it is effective for most men: In one study, it relieved impotence in almost 70 percent of men. It may not be safe for some men with cardiovascular disease.

For these men, there are other treatment options for ED, though they are more invasive or cumbersome. One option is a penile suppository, which is inserted into the urethra 10 to 30 minutes before intercourse; a drug is dispensed that widens arteries in the penis, triggering an erection that lasts 30 to 60 minutes in about two thirds of men most of the time. The drug, called alprostadil, can also be administered by injection with an ultrathin needle into the base of the penis (which may produce infection or scarring as side effects).

A third option is a vacuum erection device (VED)a pump that draws blood into the penis. It may seem awkward, but it has a very low failure rate and no serious side effects.

By contrast, a penile implant, consisting of a bendable rod or an inflatable cylinder connected to a tiny pump, has drawbacks that make it the least popular option. Not only does an implant require surgery, but implants may fail or become infected, and then must be removed. Be sure to get a second, or even third, opinion before getting an implant.

Beyond Home Remedies: When To Call Your Doctor

Contact your doctor if you are consistently unable to achieve or maintain an erection. Also contact your physician if new medications you are taking have caused a change in erectile function, or if work-related stress or other psychological factors are affecting your sexual abilities. (The side effect of many prescription drugs for depression, allergies, and heart disease is ED.) More than 200 medications currently on the market can seriously disrupt sexual performance.

What Your Doctor Will Do

The first thing your doctor should do is take a detailed medical and sexual history. If mild to moderate ED is diagnosed, your doctor may recommend a qualified urology specialist, who can perform tests to see if blood flow into the penis is adequate. The specialist may also check to see whether spinal cord problems might be involved or if blood testosterone levels are low.

If your problem is largely psychological, your physician should counsel you or refer you and your partner to a therapist. (If you are awakening at night or in the morning with a full, firm erection, then the cause of the dysfunction is most likely psychological.) Sex therapy offers a cure rate of 60 to 80 percent for erectile problems caused by psychological causes. If counseling is in order, a referral from your doctor or from a psychologist is probably the best way to find a properly certified sex therapist, although some family practitioners may have training in sexual therapy.

If the problem is associated with medication you are taking, your doctor will talk with you about alternative medications that will not affect your ability to have an erection.

For impotence that cannot be treated by any other means, some medical solutions are available. Be sure to try all nonsurgical options before considering a penile implant.